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31A-173 (8)
BP-2023-0404 40 MAYNARD RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-173-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0404 PERMISSION IS HEREBY GRANTED TO: Project# windows 2023 Contractor: License: Est. Cost: 13638 PELLA PRODUCTS, INC 096558 Const.Class: Exp.Date: 03/01/2024 Use Group: Owner: B SMITH STEPHEN E &JOLIE Lot Size (sq.ft.) Zoning: URB Applicant: B SMITH STEPHEN E&JOLIE Applicant Address Phone: Insurance: 40 MAYNARD RD NORTHAMPTON, MA 01060 ISSUED ON: 04/04/2023 TO PERFORM THE FOLLOWING WORK: 6 REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: itfht '' 3- i • , l Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner r' .14;3'. ....%•'--s--------.. The Commonwealth of Massachusetts 4p FOR U-71 Board of Building Regulations and Star lards MUNICTPALITY Massachusetts State Building Code, 780- 2 c USE �,. Building Permit Application To Construct,Repair,Renovate lish a Revised Mar 2011 One-or Two-Family Dwelling "1a F;, -` This Section For Official Use Only ,()150 Buildinf Permit Number: $P-2',4 - yO y Date Applied: K=�h..)a) Z Li. i-l-2o23 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers N a©3 OrJ- L X I 1.1 a Is this an accepted street?yes )( no Map Number Parcel Number 3 Zoning Informatio9: 1.4 Property Dimensions: 3►OJ1ltla I l-Y) , Zoning District Propose "9" Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owne 'of Record: col► rn�h �o►Hhar pDn1 Mak ()woo Name( nnt) City,State,ZIP Li6 MQ 1Qrdc reed I;-?;l&—Pip jolle. imr1 h y i l,cOry No.and Street) Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Specify:Eje 0 61,)1 VJ i r e Brief Description of Proposed Work': (plb nb ChanCps ) ui ings n if. ,_ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only _(Labor and Materials) 1.Building $ 13 t te3F' 10 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee ,er ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ n List: 5. Mechanical (Fire $ Total All Fees: Suppression) /l pp ) Check No.1(j Check Amount: �"t a Cash Amount: 6.Total Project Cost: $ (3r 653.53 '7 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) O, -M/ b v55 119 1 revor 7317r � License Number Expi tion Date Name of CSL Holder J � � List CSL Type(see below) t/l.. Not.and Street e r a c T e Description /�r Unrestricted(Buildings up to 35,000 cu.ft.) Cl:t/el tl J1 0 'r-\ CA 1 R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering a WS Window and Siding SF Solid Fuel Burning Appliances LI I rl-51a-sg14 f imt1-3( lla S. I Insulation Telephone Email a e ,ss Coin D Demolition 5.2 Registered Home Improvement Contractor(HIC) F' f /hecry 1 I�1 tr7� a� t re n C HIC Registration Number xpira ion Date HIC ompany Name or HIC Registrant.Name /G.5 Main s-r-e-e} p (lnn ape/ ,Cti ) N and Stre En aS it address rr_nfiP Id, IVi ft Ol .)l 0/5-so -.o.7 ity/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes . 0 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINNG PERMIT I,as Owner of the subject property,hereby authorize 0 t' .1\a.Proa i.f eAs to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) i Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application/-is true and accurate to th- >my knowledge and understanding. L. if ' - I 1 unr B �. ' --'-' �- c Jaz 3 Print Owner's or Authorized nt's Name(Electronic Sign..bi e) i Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" DocuSign Envelope ID:7BEB9218-159D-4F31-BB18-AE3F25A1D5A1 Contract - Detailed `//� �jA Pella Window and Door Showroom of West Springfield Sales Rep Name: Lukomski,Adam 69 Ashley Avenue Sales Rep Phone: (413) 335-3237 West Springfield, MA 01089 Sales Rep Fax: 413-774-6348 Phone: (413)736-9239 Fax: (413) 736-3390 Sales Rep E-Mail: alukomski@pellasales.com Customer Information Project/Delivery Address Order Information Jolie Smith Smith Jolie and Steve 40 Maynard Rd Northampton MA Quote Name: Lifestyle Series 2nd Floor 413-320-8596 Phase 40 Maynard Rd 40 Maynard Rd Order Number: 739Y2CL011 NORTHAMPTON,MA 01060-2810 Lot# Quote Number: 16444075 Primary Phone: (413)3208596 NORTHAMPTON,MA 01060-2810 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: joliebsmith@hotmail.com Quoted Date: 2/1/2023 Great Plains#: 1006587205 Customer Number: 1010400990 Customer Account: 1006587205 Line# Location: Attributes 10 2nd Floor Lifestyle, Double Hung, 31.5 X 49.25,Without HGP,White Item Price Qty Ext'd Price $2,662.11 6 $15,972.66 r - MINN 1: Non-Standard SizeNon-Standard Size Double Hung,Equal rgi 111MI. PK# Frame Size: 31 1/2 X49 1/4 41111111111 AIM 2130 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16",Jambliner Color: Gray Exterior Color/Finish: Standard Enduraclad,White • Interior Color/Finish: Bright White Paint Interior Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude o Hardware Options: Cam-Action Lock,Champagne,No Limited Opening Hardware,No Sash Lift,No Integrated Sensor Viewed From Exterior Screen: Full Screen,White,InViewTM Performance Information: U-Factor 0.30,SHGC 0.27,VLT 0.50,CPD PEL-N-35-00426-00003,Performance Class LC,PG 40,Calculated Positive DP Rating 40,Calculated Negative DP Rating 40,Year Rated 08111,Clear Opening Width 28.312,Clear Opening Height 21.375,Clear Opening Area 4.202562,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: SDL w/Spacer,No Custom Grille,7/8",Traditional(3W2H/3W2H) Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=162". Frame Size:31.5"X 49.25" EXTTRIMIO-PVC Ripped for stops Qty 1 LP-1 -Lead safe practices this opening Qty 1 PF-2-Exterior Pocket Installation Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 3/24/2023 Contract-Detailed Page 1 of 6 DocuSign Envelope ID:7BEB9218-159D-4F31-BB18-AE3F25A1D5A1 uuswrner. Julie anu«r rru)eut Name: Smith Jolie and Steve 40 Maynard Rd Northampton Order Number: 739Y2CL011 Quote Number: 16444075 MA [Project Checklist has been reviewed Stephen Smith Adam Lukomski Order Totals Customer Name (Please print) Pella Sales Rep Name (Please print) ,-Docusigned by: 1-DocuSigned by: Taxable Subtotal $10,532.47 SftiLtk. SwttAl.. (lb* I,14.ewtSCI Sales Tax @ 6.25% $658.28 •-----DalttnettireAeSignature ' oiReltasieetRep Signature 3/24/2023 3/24/2023 Non-taxable Subtotal $2,448.01 Total $13,638.76 Date Date Deposit Received $0.00 Amount Due $13,638.76 Credit Card Approval Signature For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 3/24/2023 Contract-Detailed Page 6 of 6 DocuSign Envelope ID:7BEB9218-159D-4F31-BB18-AE3F25A1D5A1 �y��'�"' Pella Products Inc. / 155 Main Street Greenfield, MA 01301 To Whom it may Concern: ',Stephen Smith , as property owner, give permission to our contractor, Pella Products Inc. to obtain a building permit for the installation of windows and/or doors in my home. Located at; 40 Maynard Rd Northampton, MA 01060 Please accept this letter in place of my signature on the permit application. Thank you, DocuSigned by: Signature: 91-17 n, \—D4372D2FB6134A7_. Date: 3/24/2023 ��■� PELLPRO-01 CHRISTINE ,a►CORO` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `...�' 1/3/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CQME:NTACT Christine Sullivan r Phillips Insurance Agency,Inc. PHONE FAx 97 Center Street (A/C,No,Est):(413)594-5984 (AIC,No):(413)592.8499 Chicopee,MA 01013 nn'bAdEss:christine©phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIL II INSURER A:EMC Insurance Companies 21415 INSURED INSURER B:EMCASCO Insurance Co Pella Products,Inc INSURER C: 155 Main St .INSURERD: Greenfield,MA 01301 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMBS LTRINSD WVD IMM/DD/YYYYI IMMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6A15382 1/1/2023 1/1/2024 REM sEs cEarrDence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X �� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ( MBINED Ea ccidenntSINGLE LIMIT $ 1,000,000 X ANY AUTO 6Z15382 1/1/2023 1/1/2024 BODILY INJURY(Per person) $ - OWNED 1 SCHEDULED AUTOSO ONLY AUTOS yy p pBODILY INJURY M(Per accident)_J AU- TOS ONLY NON-OWNED,ONLY (Per a ident) GE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAR CLAIMS-MADE 6J15382 1/1/2023 1/1/2024 AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION X S ATUTE OTH- ER _ AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN 6H15382 1/1/2023 1/1/2024 E L.EACH ACCIDENT $ 500,000 OFFICER/MEMBgER EXCLUDED? N N/A (Mandatory In NH) E.L.DISFASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Installation Floater$100,000 Included Operations usual to the sale and installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POUCY PROVISIONS. 212 Main St Northampton,MA 01060 AUTHORIZED REPRESENTATIVE,, ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents 1.1). wit Office of Investigations sw . 6 Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 ww».mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Pella Products, Inc Address: 155 Main st City/State/Zip:Greenfield MA. 01301 Phone #:413-774-7231 Are you an employer? Check the appropriate box: Type of project(required): 1.El I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.1:::1 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:EMC Insurance Company Policy#or Self-ins. Lic. #:6H 15382 Expiration Date:1/1/2024 Job Site Address: 40 Maynard Rd City/State/Zip:Northampton, MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi in er the pains and n s of perjury that the information provided above is true and correct Signature: Date: 03/28/23 Phone#: 413-51 -5968 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5E'lumbing Inspector 61:Other Contact Person: Phone#: PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: (,), 0p To: eiki OII91T1t C aii qatn_ Subject: Disposal of Debris The purpose of this letter is to certify that all debris from any project undertaken by Pella Products, Inc. in your town will be transported to a dumpster at our main facility; 155 Main Street, Greenfield, MA. Pella Products, inc. is under contract with Waste Management of Massachusetts For the disposal of the contents of this dumpster. Very truly yours, PELLA PRODUCTS, INC. - .. Joy Grover Accounting Manager Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-512-5968 Cell:413-834-8799 To: Building inspector From:Trevor Bross—Installation Manager Date: February 17, 2022 Subject: Building Permit Applications& Designees Pella Products Incorporated is in the business of replacing windows and doors for our customers. Our process includes providing a building permit for each and every project. I am a licensed Construction Supervisor. Building Permits will be applied for using my CSL#CS-096558 and my HIC# 142279. Please find a copy of my licenses below. Commonwealth of Massachusetts Construction SupervisorDivision of Occupational Licensure Unrestricted -Buildings of any use group which contain Hoard of Budding R ulabons and Standards �t r less than 35,000 cubic feet(991 cubic meters)of enclosed i Consoilapw$ visor space. CS 096558 ' t l�pires:0310112024 TREVOR BR9SS _ :r 10 GEORGE 8 GREENFIELIT)tA-.. '"InIV.t 11Y Failure to possess a current edition of the Massachusetts State Budding Code is cause for revocation of this license. ConlmtSstoner ,� R 1. / emdmR. ... ((11 For information about this license Call(617)727.3.200 co visit www.nwis.govldpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 142279 03i23/2024 Boston,MA 02118 'ELLA PRODUCTS.INC. :' -REVOR BROSS .�` 55 MAIN STREET 3REENFIELD,MA 01301 Undersecretary Not valid without signature Each Installation will be staffed by our installers who are all licensed in accordance with current building,codes. Below listed are our installers and their license numbers. Please accept these individuals as my designees. Willard Brown CS106010 Vladimir Shevchuk CSSL099209 Scott Bowdish CSSL100232 Bill Leger CS89338 Christian Lambert CS065102 Robert Kairnes CS113305 Igor Kravchuk CS094911